Individual ProviderJacqueline JaquezCommunity/Behavioral HealthAgenciesPractice Address915 N Erie St, Toledo, OH 43604-1605(419) 776-1757(419) 241-9277PECOS EnrollmentBased on the most recent information from CMS, provider Jacqueline Jaquez does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1639752702Provider TypeIndividualFull NameJaquez, JacquelineCredentialQMHSGenderFemaleSole ProprietorYesEnumeration Date5/5/2021Last Updated5/5/2021Contact InformationPractice LocationPractice Address915 N Erie St, Toledo, OH 43604-1605Phone(419) 776-1757FaxUnlisted FaxMailing LocationMailing Address2283 Ashland Ave, Toledo, OH 43620-1205Phone(419) 241-9277FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode251S00000XPrimaryDescriptionCommunity/Behavioral HealthAgenciesLicenseUnlisted Issuer